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ISSN 0964-1886

VOLUME 24 NUMBER 1
Spring 2003


CONTENTS

3 Editorial
Adrian Ward

Leadership
5
Who's in charge here? — Managing the mess
John Diamond

Abstract: This paper was written for the annual conference of the Association of Therapeutic Communities (ATC) held at Windsor in September 2002. The title of the conference was 'Who's in charge here'. This paper is the author's interpretation of that conference title and as such, uses examples of situations that the author found himself managing in his first year as Director of the Mulberry Bush School, a therapeutic school and member of the Charterhouse Group of Therapeutic Communities, an organization which promotes and supports therapeutic work with children and adolescents.

23 Leadership in a therapeutic environment: "What a long, strange trip it is"
Richard Rollinson

Research
37
Clinical effectiveness of an accurate psychiatric day hospital run on therapeutic community lines
Helena A. Crockford, Joan Brunton and Tammy E. Surgenor

Abstract: Day hospitals have been a widespread constituent of adult mental health services. However they have often run without clearly defined service models, and rarely been systematically studied. This naturalistic study explored the clinical effectiveness of a day hospital for acute psychiatric patients run on therapeutic community lines.
Outcome data was collected as part of routine service delivery so measurement was restricted by pragmatic considerations. Patients completed the BSI and IIP-32 questionnaires. Staff rated health and social functioning on the Health of the Nation Outcome Scales (HoNOS). The measures were completed at admission, mid-treatment, discharge and follow-up.
Results are presented for patients who were admitted and had a planned discharge within a two year period (N=56). Statistically significant improvement between admission and discharge was found on all measures. Clinical significance was established, using a modification of the Jacobson and Truax (1991) method and by comparison with other studies. Methodological constraints and key features of the service model are discussed.

55 Is frequency of absences from a daytime therapeutic community related to the seniority of the current members? An investigation of containment and stability in therapeutic communities.
Steve Pearce

Abstract:
Objective: The culture of therapeutic communities is carried to a great extent by the more senior patient-members. This study was designed to determine whether the seniority of current patient-members of a therapeutic community affected the functioning of the community, as measured by frequency of absences.
Method.’ Admission and discharge data for 1999 at a daytime therapeutic community were analysed and compared with member absences. The correlation between average duration of treatment for all members at any time point (average seniority) and the number of non-planned absences was calculated.
Results.’ There was no significant correlation (at the 0.01 level, 2-tailed) between member absences and the average seniority of current members. Absences peaked in December and August.
Conclusions: The seniority of current members did not have a detectable effect on member absences in this sample.

Training
63
Staff training in Greek Therapeutic Communities for drug addicts: an experiential approach Anna Tsiboukli and Kim Wolff

Abstract: Training staff to combat drug use is not an easy task given the range of different treatment models and professionals in this field. Treatment models range from pharmacotherapies through outpatient approaches to drug-free self-help groups and therapeutic communities. Staff working in Greek therapeutic communities for drug addicts constitute a mixed group, ranging from some who have already acquired a professional identity through university studies to others being ex-addicts who base their work mainly on a personal treatment experience. This present paper is focused around the experiential approach to training programmes in the drug addiction field. Consideration is given to the origins in a generic TC with special reference made to the therapeutic communities movement in the Greek context. The development and history of training within hierarchical TCs will be explored and the tensions between the professional staff group and the ex-addict staff group will be discussed. The paper suggests that the improvement of existing services and the development of better facilities for drug addicts and their families require greater emphasis and resource allocation for staff training.

Book reviews
77
Person-Centered Therapy Today: New Frontiers in Theory and Practice
By Dave Mearns and Brian Thorne
Reviewed by Grigoris Mouladoudis

78 Listening to young people in school, youth work and counseling
By Nick Luxmoore
Reviewed by Grigoris Mouladoudis

79 Person centered counseling in action, (2nd Ed.)
By Dave Mearns and Brian Thorne
Reviewed by Grigoris Mouladoudis


EDITORIAL

Adrian Ward

Leadership is the key theme of the opening pair of papers in this issue, and I am delighted that we are carrying, back to back as it were, papers by Rich Rollinson, the Director of the Mulberry Bush School for ten years from 1991 – 2001, and by John Diamond, Rich’s successor. These two papers give what I believe to be a unique insight into that most defining period in the life of any community, the change of leadership. I am not aware of any other occasion when this changeover has been so fully documented and reflected upon through the publication, as here, of a pair of papers by the outgoing and incoming leaders. These papers were originally written for different audiences and with different purposes, and they are both written in different personal styles. Rich’s paper was commissioned for the new volume in the Jessica Kingsley TCs series, Therapeutic Communities for Children and Young People (Ward et al, 2003), whereas John’s was given as a lecture at the Windsor Conference in 2002. It was always my hope that we could bring the two papers together, however, and this issue has created the opportunity to do so.

As Rich’s paper conveys, he had been intimately involved in the life of the Mulberry Bush for many years even before he took on the Directorship. He faced considerable challenges when he originally took on the role, as the School was in need of renewal and revival after a time of real uncertainty. Rich’s paper traces his personal and professional path through the subsequent challenges and changes throughout his period of leadership. It is a highly personal account which nevertheless draws out a number of essential ‘themes and issues’, and it thus demonstrates exactly what is required of a leader in such a setting - the ability and willingness to draw constructively and thoughtfully upon these personal and professional demands, to separate out the various levels of transference, counter-transference and projective identification which will operate throughout the place, and yet to remain both authentic and authoritative. This is what Rich means by the need to ‘hold the line’.

By the time an established and respected leader is ready to step down it will at first seem as impossible that the place will manage without them as it probably did when they originally took up post. The history of TCs is not encouraging in this respect -we all know of communities which have been built up around the egos of charismatic leaders who have then been unable to move on without the place crumbling or at least stumbling. Some such communities never fully recover from the departure of their founding parent, while others do eventually manage to make the transition - sometimes to the great cost of an interim leader or of other senior staff. As a previous editor of this journal wrote elsewhere, ‘Therapeutic communities seem to be especially favourable soil for the blooming of charisma (. . .) But more therapeutic benefit would come from a fully conscious and verbal understanding of the dramatization to be dealt with’ (Hinshelwood, 1987, 226).

It was not long after Rich took up his Director’s role that John moved from the Cotswold Community to become Head of Residential Therapy at the Bush. His extensive experience at Cotswold, plus his training on the MA in Therapeutic Child Care at Reading University, placed John in an ideal position to move into that role, a role which, as it turned out, gave him a substantial grounding in the dynamics of leadership before his successful application for the Directorship.

John’s own paper moves us ten years forward and demonstrates how he experienced his own challenges on taking up the leadership. As in Rich’s paper, there are intense vignettes of the ways in which the children and staff experienced this renewed turmoil, and again John draws out key themes, especially in terms of the ‘Janus’ position of leadership - looking hoth inside and out. The suffering of individuals and groups, both symbolically and otherwise, makes for painful reading in this paper, although it is again an authentic representation of the seriousness of the issues facing both the community and its leader.

The hardest challenge ultimately facing the leader is that of succession: how to leave the community with the enterprise intact and thriving, with the path ahead ready for the incoming leader, but with the outgoing leader also intact and ready for their own future. This is a task which cannot wait until the last day of a leader’s tenure, as is demonstrated in this pair of papers. I know that John will have this theme at the back of his mind, and I am confident that (although it is sometimes said that there is a diminishing ‘pool’ of potential leaders in this field) the next leader of the Bush is somewhere even now unwittingly preparing for that responsibility.

Leadership is also topical in relation to the production of the journal itself, as my own tour of duty as editor comes to an end at the close of this year. We are currently seeking a replacement, and all those interested are invited to contact either Rex Haigh or myself. Editing the journal is a different task from leading a TC, of course, but it does entail some similar tasks and dynamics. There are certainly competing internal and external demands, and there are moments when the intense personal feelings of authors and others need to be understood and managed, although for most of the time these dynamics operate at a much less extreme level than in the average TC. It is a rewarding position, enthralling at times, not least in that it gives you the regular opportunity to reflect on the key and current themes in Therapeutic Community work. I will be glad to discuss this at further length with those interested in the post.

Adrian Ward
Editor

References
Hinshelwood, RD. (1987) What Happens in Groups. London, Free Association.

Ward, A., Kasinski, K., Pooley, J. and Worthington, A. (eds) (2003) Therapeutic Communities for Children and Young People. London, Jessica Kingsley.

 

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